METACOGNITIVE THERAPY FOR ANXIETY AND DEPRESSION
CONTENTS C H A P T E R THEORY AND NATURE OF METACOGNITIVE THERAPY THE NATURE OF METACOGNITION TWO WAYS OF EXPERIENCING: MODES THE METACOGNITIVE MODEL OF PSYCHOLOGICAL DISORDER THE CAS CONSEQUENCES OF THE CAS POSITIVE AND NEGATIVE METACOGNITIVE BELIEFS SUMMARY OF THE METACOGNITIVE MODEL A REFORMULATED A-B-C MODEL A NOTE ON PROCESS- VERSUS CONTENT-FOCUSED THERAPIES CONCLUSION C H A P T E R ASSESSMENT OPERATIONALIZING THE A-M-C MODEL BEHAVIORAL ASSESSMENT TESTS IN ANXIETY QUESTIONNAIRE MEASURES RATING SCALES A SEVEN-STEP ASSESSMENT PLAN FOUNDATION METACOGNITIVE THERAPY SKILLS IDENTIFYING AND SHIFTING LEVELS DETECTING THE CAS USING A METACOGNITIVE-FOCUSED SOCRATIC DIALOGUE METACOGNITIVELY FOCUSED VERBAL REATTRIBUTION METACOGNITIVELY DELIVERED EXPOSURE ATTENTION TRAINING TECHNIQUES OVERVIEW OF THE ATT RATIONALE FOR THE ATT CREDIBILITY CHECK SELF-ATTENTION RATING BASIC INSTRUCTIONS FOR THE ATT PATIENT FEEDBACK HOMEWORK TROUBLESHOOTING OUTLINE OF THE FIRST ATT SESSION CASE EXAMPLE SITUATIONAL ATTENTIONAL REFOCUSING DETACHED MINDFULNESS TECHNIQUES AIMS OF DM ELEMENTS OF DM AN INFORMATION-PROCESSING MODEL OF DM DM AND OTHER FORMS OF MINDFULNESS TEN TECHNIQUES REINFORCING DM USING SOCRATIC DIALOGUE APPLICATION OF DM IN MCT GENERALIZED ANXIETY DISORDER THE UBIQUITY OF WORRY IS WORRY CONTROLLABLE? THE METACOGNITIVE MODEL OF GAD THE MODEL IN ACTION STRUCTURE OF TREATMENT CASE CONCEPTUALIZATION SOCIALIZATION BRIDGING FROM SOCIALIZATION TO METACOGNITIVE MODIFICATION QUESTIONING UNCONTROLLABILITY BELIEFS DETACHED MINDFULNESS AND WORRY POSTPONEMENT CHALLENGING UNCONTROLLABILITY BELIEFS CHALLENGING DANGER METACOGNITIONS BEHAVIORAL EXPERIMENTS CHALLENGING POSITIVE METACOGNITIVE BELIEFS NEW PLANS FOR PROCESSING RELAPSE PREVENTION GAD TREATMENT PLAN POSTTRAUMATIC STRESS DISORDER CAS IN PTSD METACOGNITIVE BELIEFS THE METACOGNITIVE MODEL OF PTSD PRESENTING THE TREATMENT RATIONALE DETACHED MINDFULNESS AND RUMINATION/ WORRY POSTPONEMENT APPLICATION OF DM AND RUMINATION/ WORRY POSTPONEMENT GENERALIZATION TRAINING ELIMINATING OTHER MALADAPTIVE COPING STRATEGIES ATTENTION MODIFICATION RESIDUAL AVOIDANCE PTSD TREATMENT PLAN OBSESSIVE–COMPULSIVE DISORDER OVERVIEW OF MCT: OBJECT LEVEL VERSUS META LEVEL TWO TYPES OF METACOGNITIVE CHANGE THE CAS IN OCD STOP SIGNALS THE METACOGNITIVE MODEL OF OCD ENGAGEMENT: NORMALIZING AND DESTIGMATIZING DETACHED MINDFULNESS INCREASING COMPLIANCE WITH ERP AND ERC CHALLENGING SPECIFIC METACOGNITIVE BELIEFS ABOUT THOUGHTS CONTAMINATION FEARS: A SPECIAL CASE? MODIFYING BELIEFS ABOUT RITUALS BEHAVIORAL EXPERIMENTS AND BELIEFS ABOUT RITUALS NEW PLANS FOR PROCESSING: STOP SIGNALS AND CRITERIA FOR KNOWING OCD TREATMENT PLAN MAJOR DEPRESSIVE DISORDER RUMINATION AND DEPRESSIVE THINKING THE CAS IN DEPRESSION THE METACOGNITIVE MODEL OF DEPRESSION ENHANCING MOTIVATION HELPING PATIENTS UNDERSTAND THE ROLE OF BEHAVIORS ATTENTION TRAINING DETACHED MINDFULNESS AND RUMINATION POSTPONEMENT IMPLEMENTING DM TECHNIQUES MODIFYING NEGATIVE METACOGNITIVE BELIEFS MODIFYING POSITIVE METACOGNITIVE BELIEFS MODIFYING THREAT MONITORING MALADAPTIVE COPING WITH MOOD FLUCTUATION FEAR OF RECURRENCE A NOTE ON SUICIDALITY AND SELF-INJURY DEPRESSION TREATMENT PLAN C H A P T E R 1 0 THE EVIDENCE FOR METACOGNITIVE THEORY AND THERAPY THE EXISTENCE AND CONSEQUENCES OF THE CAS INTERIM SUMMARY CAUSAL STATUS OF THE CAS AND METACOGNITIONS DOES METACOGNITION CONTRIBUTE TO DISORDER ABOVE ORDINARY COGNITION? MODEL TESTING: DATA FROM PATH ANALYSES AND STRUCTURAL EQUATION MODELING SUMMARY OF EVIDENCE ON THEORY THE EVIDENCE ON TREATMENT CONCLUDING THOUGHTS SPECIFICATIONS OF A TRANSDIAGNOSTIC TREATMENT A UNIVERSAL FORMULATION NEUROBIOLOGY AND MCT MCT IN A WIDER CONTEXT CLOSING REMARKS THEORY AND NATURE OF METACOGNITIVE THERAPY THOUGHTS DON’T MATTER BUT YOUR RESPONSE TO THEM DOES EVERYONE HAS NEGATIVE THOUGHTS AND EVERYONE BELIEVES THEIR NEGATIVE THOUGHTS SOMETIMES BUT NOT EVERYONE DEVELOPS SUSTAINED ANXIETY, DEPRES- SION, OR EMOTIONAL SUFFERING AN IMPORTANT QUESTION IS: WHAT IS IT THAT CON- TROLS THOUGHTS AND DETERMINES WHETHER ONE CAN DISMISS THEM OR WHETHER ONE SINKS INTO PROLONGED AND DEEPER DISTRESS? THIS BOOK OFFERS AN ANSWER TO THIS QUESTION IT PROPOSES THAT META- COGNITIONS ARE RESPONSIBLE FOR HEALTHY AND UNHEALTHY CONTROL OF THE MIND FURTHERMORE, IT IS BASED ON THE PRINCIPLE THAT IT IS NOT MERELY WHAT A PERSON THINKS BUT HOW HE OR SHE THINKS THAT DETERMINES EMOTIONS AND THE CONTROL ONE HAS OVER THEM THINKING CAN BE LIKENED TO THE ACTIVITY OF A LARGE ORCHESTRA INVOLVING MANY PLAYERS AND INSTRUMENTS TO PRODUCE AN ACCEPTABLE OVERTURE THERE MUST BE A MUSIC SCORE AND A CONDUCTOR METACOGNITION IS THE SCORE AND THE CONDUCTOR BEHIND THINKING METACOGNITION IS COGNITION APPLIED TO COG- NITION IT MONITORS, CONTROLS, AND APPRAISES THE PRODUCTS AND PROCESS OF AWARENESS FOR MOST OF US, EMOTIONAL DISCOMFORT IS TRANSITORY BECAUSE WE LEARN WAYS OF FLEXIBLY DEALING WITH THE NEGATIVE IDEAS (IE, THOUGHTS AND BELIEFS) THAT OUR MINDS CONSTRUCT THE METACOGNITIVE APPROACH IS BASED ON THE IDEA THAT PEOPLE BECOME TRAPPED IN EMOTIONAL DISTURBANCE BECAUSE THEIR METACOGNITIONS CAUSE A PARTICULAR PATTERN OF RESPONDING TO INNER EXPERI- ENCES THAT MAINTAINS EMOTION AND STRENGTHENS NEGATIVE IDEAS THE PATTERN